新京报讯 (记者魏铭言)北京市卫生局拟于近日出台《关于进一步加强医疗机构急诊工作的通知》。“急诊新政”将对推诿急诊患者的医院向社会公开通报批评，对不能胜任和承担急诊抢救工作的医院，卫生行政部门要重新审核该医疗机构的能力和级别，对达不到要求的医疗机构“降级、降等”。这意味着，今后，医院急诊科以“没床没设备”拒接病人，医院拟被降级。

The Beijing news - (Reporter MingYan wei)The municipal bureau of health issued by recently[On further strengthening the work of emergency medical institutions notice]."Emergency New Deal"To shuffle emergency patients to the hospital public notice of criticism,Cannot be competent for and take emergency rescue work of hospital,The public health administrative departments should review the medical institution's ability and level,Can not reach the requirements of medical institutions"degradation/demotion".This means that,In the future,Hospital emergency department to"No bed not equipment"Rejected by the patient,The hospital intends to be demoted.

　　急诊须落实“首诊负责制”

Emergency shall carry out"First diagnosis responsibility system"

　　11月中旬，被称为“急诊科女超人”的协和医院急诊科医生于莺在其实名认证的微薄上吐嘈：一位昏迷老人在急救车上辗转五家医院急诊科，未能被接治。此事引发讨论和反思。

In the middle of November,called"Ed superwoman"The union medical college hospital emergency department doctor in the name of the poor in actually authentication on travel vomit:A man in a coma ambulance toss five hospital emergency department,Failed to was taken to.This trigger discussion and reflection.

　　北京市卫生局局长方来英说：“这件事首先暴露出的是医疗道德问题。在任何情况下，急诊不能拒接病人。”

The municipal bureau of health director party to the said:"It is first exposed medical moral problems.In any case,Emergency not rejected by the patient."

　　据悉，院前急救系统(指120和999)转送患者应遵循“就近、就急、就能力”的原则并参考患者或家属的意见。

It is reported,Prehospital emergency system(Refer to the 120 and 999)Transfer patients should follow"near/nasty/Ability is"The principles and reference the opinions of the patient or family member.

　　根据属地管理的权责，市卫生局将在《关于进一步加强医疗机构急诊工作的通知》，为确保患者进入医院后“有人管”，《通知》强调，急诊也须落实首诊负责制。

According to apanage management responsibility,The municipal bureau of health, will be in[On further strengthening the work of emergency medical institutions notice],To ensure that patients in hospital"Someone tube",[notice]emphasize,Emergency must implement the first diagnosis responsibility system.

　　市卫生局医政处相关负责人说，接诊医师为首诊医师，须及时对患者做出初步诊断。首诊医师抢救急、危、重症患者，在病情稳定之前不得转院。

The municipal bureau of health, medical administration in the relevant person in charge said,Accepts doctor diagnosis led doctors,Should be timely to patients to make preliminary diagnosis.The first clinical doctors rescue urgent/dangerous/In severe cases,In a hospital in stable condition not before.

　　此外，对拒绝或推诿急诊患者的医护人员，市卫生局将对其不良行为纳入医德医风考评档案，并与医师执业资质注册和技术职称评定挂钩。

In addition,To refuse or shuffle in patients with emergency medical personnel,The municipal bureau of health, will the bad behavior of medical ethics appraisal files into,And with physician practice qualification registration and technical title evaluation hook.

　　急诊科有望实行内部分级诊疗

Ed is expected to implement internal classification diagnosis and treatment

　　不少患者挂急诊号看常见病，或者慢性病急性发作的病人，度过危险期后，仍不愿转向基层医院，滞留急诊抢救室，是让很多大医院急诊科医生头痛的问题。

Many patients hang emergency number see common diseases,Chronic or acute attack of the patients,Through crisis after,Still don't like steering basic-level hospitals,Detention emergency intensive care,Is to make a lot of big hospital emergency department doctor headache problem.

　　《通知》规定，各医疗机构要支持和加强急诊科建设，在急诊高峰期时调配足够力量，保障急诊运行。要优化就医流程，开辟绿色通道，按照复苏、抢救、重症和轻症分级诊疗，解决急、危、重症患者的优先救护问题。

[notice]provisions,The medical institutions to support and strengthen the construction of the emergency,In rush hour emergency deployment of sufficient strength,Security emergency operation.To optimize medical process,Open up the green channel,According to the recovery/rescue/Severe and light disease diagnosis and classification,Solve urgent/dangerous/In severe cases, the preferred rescue problem.

　　方来英说，救治病人分“轻重缓急”，一直是急诊科的工作原则。至于是否会存在一些医生担心的社会环境不允许，患者不理解等问题，方来英认为，需要执行一段时间看效果，但他认为绝大部分患者会理解，会尊重急症病人的优先抢救。

Party to the said,Treatment the patient points"priorities",The difference is always working principle.As for whether there will be some doctors worry about social environment are not allowed,Patients do not understand problems,Party to British think,Need to implement a period of time to see effect,But he thinks that most of the patients will understand,Will respect emergency patients preferred rescue.

　　■ 释疑

S disabuse

　　1 急诊科推诿病人是否常态？

1 emergency department patients shuffle is normal?

　　【一线声音】

[A line sound]

　　推诿病人是个案

Shuffle the patient is the case

　　中日友好医院急诊科主任张国强说，急诊科推诿病人、急诊找床位靠运气的情况确实存在。但他强调，只是少数。

The sino-japanese friendship hospital emergency department director zhang guiquan said,Emergency department patients shuffle/Emergency find bed luck situation does exist.But he stressed that,Just a few.

　　他说，作为急诊科医生，只要诊疗条件允许，医生不会往外推，这是职业要求。对于危重症患者，我们可以跪在地板上去强求。

He said,As the emergency clinician,As long as the medical conditions allow,The doctor will not push out,This is the professional requirements.For critically ill patients,We can kneeling on the floor up to demand.

　　【官方回应】

[The official response]

　　是个案但不能“容忍”

Be the case but can't"tolerate"

　　北京市卫生局局长方来英说，最新的调查数据显示，120和999两个院前急救网络，最近一段时间，转运病人的一次性接诊率是98.4%。

The municipal bureau of health director party to the said,The latest survey data show,120 and 999 two pre-hospital care network,A recent period of time,Transfer the patient's one-time accepts rate is 98.4%.

　　从数据可以看出，急救车拉着病人跑几家医院的情况，应该是极个案。

Can be seen from the data,An ambulance took the patient to run a few hospitals situation,Should be very case.

　　但是他说，抢救生命，是医生的职业准则，没有人有权利漠视这1.6%的生命。

But he said,Rescue life,Is the doctor's professional standards,No one has the right to disregard the 1.6% of the life.

　　方来英说：“医生非常辛苦，特别是急诊科医生，他们承担的身体和精神上的压力，普通人难以体会。但是，我们换公众的立场想一想，如果自己是个病人，谁愿意当这1.6%？出台这样严厉的文件，就是要监督属地所有二级以上医院，职责所在，重整转诊流程也好，加强急诊科配置也好，不能拒接病人。”

Party to the said:"The doctor is very hard,Especially the emergency clinician,They assume physical and mental pressure,Ordinary people difficult to understand.but,We change the position of the public think about it,If I was a patient,Who is willing to when the 1.6%?So harsh on the file,Is to supervise apanage all level 2 above hospitals,responsibility,Reforming referral process well,To strengthen the emergency department or configuration,Not rejected by the patient."

　　2 是否导致更多患者涌向三甲医院？

2 is leading to more people flocked to the hospital?

　　【一线声音】

[A line sound]

　　非急诊者或占急诊资源

The emergency person or of emergency resources

　　根据即将出台的《通知》，开放急诊治疗的医疗机构必须接收院前急救转送的患者，依据病情轻重组织救治。是否会导致更多的非急诊患者涌向急诊科？

According to the upcoming[notice],Open the emergency treatment of medical institutions shall receive prehospital emergency transfer of the patients,According to the illness weight organization treatment.Whether it will lead to more non emergency patients flocked to the emergency department?

　　北京市卫生局医政处统计，全市66家三级医院中，半数存在老年复杂慢性病患者、终末期慢病患者长期滞留，急救床位紧缺的问题，其中朝阳医院、宣武医院、协和医院等知名三甲医院情况更严重。

The municipal bureau of health medical administration in statistics,The 66 tertiary hospital,Half of the elderly patients with chronic diseases exist complex/End-stage slow patients long-term retention,Emergency beds shortage problem,The chaoyang hospital/Xuanwu hospital/Union medical college hospital, and other well-known 3 armour hospital situation is more serious.

　　中日友好医院急诊科主任张国强担心，文件一旦下发，会在短期内引发更多非急症患者，挂急诊号治病，占用属于急危重症患者的急诊资源。

The sino-japanese friendship hospital emergency department director zhang guiquan worry,File once issued,In the short term will not cause more emergency patients,Hang the emergency number cure,Take belong to the critical patients of emergency resources.

　　他说，中日友好医院急诊科病人最多的时候，医护人员抢救只能侧身挤过去，“(这种情况下)如果再接危重症，如何能确保有效的救治？”

He said,The sino-japanese friendship hospital emergency department patients most of the time,Medical staff rescue only squeeze on my side,"(In this case)If after critically ill,How to ensure the effective treatment?"

　　【官方回应】

[The official response]

　　按意愿送急救拟签同意书

According to intend to send emergency intends to sign the agreement

　　北京市卫生局局长方来英说，一些急诊患者或家属要求救护车送病人去大医院，我们调查发现，这些患者大多数是非急危重症病人。

The municipal bureau of health director party to the said,Some emergency patients or family members wishing to an ambulance drove patients go to large hospital,Our findings,Most of these patients is the critical patients.

　　我们在考虑出台院前急救“知情同意”制度。急救医生在接到病人实施转运前，或在急救车上，要对病人的病情做一个初步诊察判断，按照“就近、就急、就能力”的原则，做出一个决定和建议。

We are considering of prehospital emergency treatment"Informed consent"system.Emergency doctor to the patient before implementation of transport,Or in an ambulance,To the patient's condition to do a preliminary consulting judgment,According to the"near/nasty/Ability is"principle,Make a decision and Suggestions.

　　如果患者或家属一定要“就意愿”去大医院，应签署《知情同意书》，对自己的坚持判断负责。这是为了让急救患者的流向，更加科学合理。

If the patient or family member must"Intend to"Go to large hospital,Shall be signed[Informed consent],To adhere to the judgment is responsible for.This is in order to make the flow of emergency patients,More scientific and reasonable.

　　方来英说，我们相信，更多的患者对医生的依从性还是很强的。我们也希望，更多急救医生和急诊科医生，拥有准确的分级检诊能力。

Party to the said,We believe that,More patients to the doctor's compliance or strong.We also hope to,More emergency doctors and emergency department doctor,Have accurate classification inspection diagnosis ability.

　　北京急诊“新政”

Beijing emergency"New Deal"

　　●开放急诊治疗的医疗机构必须接收院前急救转送的患者，依据病情轻重组织救治。

- open emergency treatment of medical institutions shall receive prehospital emergency transfer of the patients,According to the illness weight organization treatment.

　　●落实首诊负责制。首诊医师抢救急、危、重症患者，在病情稳定之前不得转院。

- implement first diagnosis responsibility system.The first clinical doctors rescue urgent/dangerous/In severe cases,In a hospital in stable condition not before.

　　处罚

punishment

　　医疗机构

Medical institutions

　　●拒绝和推诿患者的医疗机构，卫生行政部门将向社会公开通报批评。

Had refused to shuffle and patients' medical institutions,The administrative department of public health to the public will be criticized.

　　●拒绝和推诿患者的医疗机构，不得参与医院评优和医院等级评审。

Had refused to shuffle and patients' medical institutions,Shall not participate in the hospital assessment and hospital level evaluation.

　　●不能胜任和承担急诊抢救工作的医疗机构，卫生行政部门要重审其能力和级别，对不达标医疗机构须降级降等。

- can't do and take emergency rescue work of medical institutions,The public health administrative departments should review the ability and level,Standard of medical institutions shall be demoted demotion.

　　●推诿或者拒绝收治急、危、重症患者的医疗机构，要责令其限期整改；造成严重后果的，应当依法追究医疗机构负责人的责任。

- shuffle or refuse to were urgent/dangerous/In severe cases of medical institutions,To instruct its deadline rectification;Serious consequences,Shall be investigated for responsibility of the person in charge of the medical institution.

　　医务人员

Medical personnel

　　●拒绝和推诿患者，医护人员不良行为将纳入医德医风考评档案，并与卫执业资质注册和技术职称评定等挂钩。

Had refused to and shuffle patients,Medical staff will put into the bad behavior of medical ethics appraisal files,And health practice qualification registration and technical title assessment of the hook.

　　●推诿或者拒绝收治急、危、重症患者的医务人员，要责令其限期整改；造成严重后果的，应当依法追究相关人员责任。

- shuffle or refuse to were urgent/dangerous/In severe cases, the medical staff,To instruct its deadline rectification;Serious consequences,Relevant personnel shall be investigated for responsibility.

　　■ 对话

S dialogue

　　方来英：称没床拒接患者 急诊科可考虑关门

Party to the:Says no bed rejected by emergency department patients can consider to close the door

　　协和医院急诊科医生于莺的一条微博，再次让急诊科存在的问题摆在公众面前，面对有些大医院急诊科“人满为患”、急救信息不联网等现象，昨日，北京市卫生局局长方来英接受新京报记者采访。

Union medical college hospital emergency department in the doctor a micro bo,Once again let Ed problems in public,In the face of some large hospital emergency department"packed"/Emergency information networking wait for a phenomenon,yesterday,The municipal bureau of health director party to accept the new Beijing news reporters.

　　“病人就是在平板车上也要先接诊”

"The patient is in the car also first accepts"

　　新京报：据我们调查，“没床没设备”确实是很多大医院急诊科的现实，不少三甲医院的急诊科病人滞留严重。

The Beijing news:According to our survey,"No bed not equipment"It is a lot of big hospital emergency department reality,A lot of 3 armour hospital emergency department patients retention serious.

　　方来英：急诊科没有床位概念，卫生局也从未批准过急诊床位。

Party to the:Emergency department no beds concept,Health bureau have never approved emergency beds.

　　急诊是24小时开放，紧急情况下，病人就是在平板车上，也要先接诊，再根据诊断情况分流。所以，急诊后病人能否分流是医院内部管理的问题。

Emergency is open 24 hours,emergency,The patient is in the car,Also first accepts,Then according to the diagnosis shunt.so,After the emergency patients can shunt is hospital internal management problems.

　　在任何情况下，急诊科医生没权力拒接病人。

In any case,The emergency clinician not power rejected by the patient.

　　新京报：但是为什么三甲医院急科病人严重滞留？

The Beijing news:But why 3 armour hospital urgent family patient serious retention?

　　方来英：这主要是医院内外的资源布局和利益导向问题。现在卫生部门对住院的床位周转率、死亡率都有考核，这也导致很多科室不愿收治那些复杂重症的慢性病患者，内部的转诊渠道不畅。同时，目前的医保政策规定，患者在急诊留观，也可以按照住院来报销。这也导致不少可以转出去的病人，不愿转走。

Party to the:This is mainly the hospital internal and external resources layout and interest orientation problem.Now health department of hospital beds turnover/Mortality have assessment,It also lead to a lot of departments would not treated those complicated severe chronic patients,Internal referral channel.At the same time,The current medical insurance policy,Patients in the emergency department staying,Can also according to the hospital to submit an expense account.It also leads to many patients can turn out,Don't want to turn away.

　　新京报：如果以后再发生拒收病人情况，卫生部门会有什么举措？

The Beijing news:If later happen again rejected the patient's condition,Department of health will have what measures?

　　方来英：即将出台的《关于进一步加强医疗机构急诊工作的通知》，是对属地所有二级以上，开设急诊科的医院的一个行政措施。

Party to the:About to publish[On further strengthening the work of emergency medical institutions notice],Is the second class above all dependency,Set up emergency department of a hospital administrative measures.

　　今后，如果仍有医院称急诊科“没床，没能力”而拒接病人，那医院可以考虑关闭急诊科。卫生行政部门会重新评估医院的定级。如果医院不设急诊科，医院就无法被评为成为二级以上(综合)医院。

In the future,If there are still hospital emergency department said"No bed,I don't have the strength"And rejected by the patient,The hospital emergency department can be considered closed.The public health administrative department will reassess the hospital grading.If the hospital emergency department do not set,The hospital can't be named as the second class above(comprehensive)hospital.

　　急救信息联网只能作为参考

Emergency information networking only as a reference

　　新京报：目前，公众对急救资源联网的呼声非常高，市卫生局是否已着手做这一工作？

The Beijing news:At present,The public emergency resources networking call is very high,The municipal bureau of health, have set out to do the work?

　　方来英：我们计划用三年建立全市电子病历体系。院前、院内急救信息联网会一起做。

Party to the:We plan to use three years to establish the electronic medical record system.prehospital/Hospital emergency information networking will do it together.

　　但急救信息联网只能作为快速急救转运的一个参考依据。比如，在急救车上看到周边三级医院急诊提示“没床”，但病人危重，亮红灯的医院可以拒绝接受吗？

But first aid information networking only as fast emergency transport of a reference.Such as,In an ambulance see surrounding tertiary hospital emergency tip"No bed",But critically ill patients,Bright red light hospital may refuse to accept it?

　　急诊转运“就近、就急、就能力”中的“就能力”，不是就急诊科的床位和设备能力，而是就医院的救治能力。

Emergency transport"near/nasty/Ability is"of"Ability is",Not just the emergency beds and equipment capacity,But will the hospital treatment capacity.

　　新京报：急救资源联网的最大作用是什么？

The Beijing news:First aid network resources the biggest what is action?

　　方来英：院前院内急救资源联网应承担的作用是让患者的病情信息，快速传递。

Party to the:Prehospital emergency resources in network to the action is to make the patient information,Rapid transfer.

　　急救车拉上病人，急救医生可以把病人的大致情况，初步诊断的病情，传递到目的地医院急诊科。对危重病人，急诊科医生可以抢时间，提前做好抢救准备。

Ambulance pulled the patient,Emergency doctors can take the patient's general condition,The preliminary diagnosis of the disease,Transfer to the destination hospital emergency department.To critically ill patients,The emergency clinician can fight against time,Prior to the rescue.